In Conversation

‘Public health should take precedence over curative medicine’

Untitled design 5

A former head of the Department of Cardiology at All India Institute of Medical Sciences, Prof. K. Srinath Reddy is an Honorary Distinguished Professor at the Public Health Foundation of India and its past president. He also serves as an Adjunct Professor of Epidemiology at Harvard. 

In an interview with HealthLEADS, Dr Reddy makes a strong case for privileging public health in the delivery of healthcare. He contends it is crucial to train a large number of frontline health workers who can actually provide the services on the ground level in addition to the medical experts who are qualified to treat patients.

“I believe it’s very, very important for medical education to recognize that you cannot only treat a person when he has become unwell. It’s very important to try and look at how we can prevent disease and promote health,” Dr Reddy said. 

Do you think better collaboration between the media and health professionals can advance healthcare?

I think it’s absolutely important that health professionals utilize all the opportunities provided by the media for effectively communicating facts and concepts to the people at large. Without accurate information communicated in the easy to understand manner, it’s going to be difficult to bring about attitudinal or behavior change.

It’s also important to be relatively jargon free and try and simplify the concepts without necessarily giving incorrect representation of facts. Sometimes it may be necessary to use metaphors as well for ease of communication. Like, for example, when I address students in schools on healthy behaviors, somebody invariably gets up and says, “My grandfather or Winston Churchill smoked a lot and lived up to 90, whereas some of those who have not smoked died at the age of 60.” You have to explain with the metaphor that they understand. That is, if you’re driving a car and if you stop at a red light, the probability of your getting into an accident is much less than if you drive through the red light.

Some people may stop at the green light, at the red light, but may still get bumped from behind by an impatient driver. So that sometimes happens that people may be nonsmokers but still die. And some people may be able to drive through the red light when the traffic conditions are very favorable. 

So you have to give an explanation of what probability is, and then you can convey that message with greater clarity and conviction.

What is the one thing that can help us with public health communications in India? Any one specific tool you want to have included?

Well, I think now social media has become very important. But I think the most important thing is not to try and only influence individual behaviors, but group behaviors. Quite often, there are so many groups that communicate within themselves, including on social media. So it’s important to try and get the message across to all those groups. Previously, we used to have neighborhood conversations in the community, which used to influence behavior.

Even now, whether to wear a mask or not, whether to get vaccinated or not, is often dictated by peer behavior within the community. So you have to reach out at multiple levels. And social media is one larger area of connecting and communicating with a group of people. So I think the important thing is not to try and aim only at the individual, but to aim at collectives.

Have we learned enough from COVID to be prepared for the next crisis?

I think there have been several valuable lessons. And to some extent, we have improved our health systems. But have they improved our public health systems? Have we improved our risk communication methods? That, I believe, is still an incomplete job.

We need to do better. And we need to actually keep communicating about health on a regular basis. You cannot come in sporadically and then expect people to immediately become very, very obedient to whatever is being said. So unless you build that level of confidence through constancy of communication with the people, you are not likely to achieve results. 

So I believe it’s important that policymakers as well as public health people keep that conversation going on a regular basis. I do think the medical education needs to be more focused on the public health. I believe it’s very, very important for medical education to recognize that you cannot only treat a person when that person has become unwell. It’s very important to try and look at how we can prevent disease and promote health. 

Medical education, unfortunately, deals with diseases and organs. They talk about lung cancer. They talk about heart attacks. Tobacco is mentioned briefly there.  But you don’t talk about tobacco related diseases as a group and say how so many diseases can be prevented by people not taking up smoking or chewing tobacco or giving up the habit.

I think it’s very important for us to turn our attention to diet, exercise, staying away from tobacco, and not having harmful alcohol consumption. Some of these things are important messages that must go across because many of the risk behaviors and risk factors cut across multiple diseases. And every physician must learn how best to actually emphasize prevention, even when talking to patients and families, and certainly have a community connect if possible.

So public health has to become the fundamental basis of a broad based medical practice. One more thing: Public health teaches you a lot about how to interpret evidence, interpret data, how to look at whether a certain fact is being accurately assessed for its overall impact, overall level of risk. As I said, the assessment of probabilities, the public health way of evaluating evidence is very important even for a clinician.

Otherwise, you’ll run after flimsy evidence saying that the treatment A is better than treatment B unless you understand some of these methodological issues. So I believe every medical student, both from the point of view of having a community oriented mindset and from having a better understanding of research methods needs to be exposed to public health.

Do we need to address the manpower deficit in India and make it a viable career option?

Basically, what we ought to look at is whether what we call public health professionals are very well-trained in classical public health disciplines through a structured program, which is a degree or a diploma program. And secondly, our public health practitioners and functionaries who are actually performing a number of public health duties at different levels of the health system, starting from the front lines.  

To develop more of the public health professionals who can be teachers, researchers, policy enablers, health system managers and program leaders, we do need formal education, which is multi-disciplinary, which can be applied multi-sectorally. And for that, we have established several Indian institutes of public health. And many medical colleges and universities are now also taking up those public health education programs. But much more important, I believe, is to develop a huge cadre of frontline health workers who can actually deliver the services on the ground level.

And therefore, if you, for example, look at even Asha and auxiliary nurse midwives they’re being stretched beyond a point. So there is no reason why we can’t double the number of Ashas and our auxiliary nurse midwives. This will create more employment. But we should get them to do more public health related duties. With non-communicable diseases like high blood pressure, diabetes, etc, you cannot have people dealing only with maternal and child health issues or infectious diseases. You need more frontline health workers. They can be trained in a shorter period and they can create employment, particularly for women, because many of the frontline health workers are going to be women. Therefore it’s going to be a very important development imperative to create greater opportunities for women public health workers to be trained in larger numbers.

Of course, there’s no reason why women should not become doctors. They should. But I believe right now the important thing is keeping the timeframe in mind. We need broad based efforts to develop more frontline health workers who are technology enabled. Because if you say that somebody has high blood pressure at the age of 45 or high cholesterol and then treat them effectively with drugs, certainly you’re going to be adding on a number of years to their life.

But all the damage that has occurred to your blood vessels because you have been exposed to high blood pressure, recognized or unrecognized, from the age of 15 or so up to 45, cannot be reversed. So if you really want good health to last for a number of years, you cannot depend only on curative medicine. You have to depend on preventive medicine and public health measures that can promote health.

The video of the interview is here.

Read more :